[Celioscopy in digestive oncology]

In patients with suspected or patent cancer involving digestive tract organs, laparoscopy can be successfully used both as a diagnostic tool for initial diagnosis or evaluation of cancer extension and as a therapeutic tool, either in successive or in a single operation. For diagnosis, the main aim of laparoscopy is to confirm the clinical diagnosis or search for neoplastic diffusion. Diagnostic laparoscopy is particularly important in cases of advanced cancer when extension may render laparotomy unjustifiable. Needle biopsies of the liver can be obtained under visual control and non-resectable tumours can be identified. For cancer of the pancreas laparoscopic findings are highly specific, reaching 100% in cases with peritoneal carcinoma. Laparoscopy has similar advantages for staging cancer of the gall bladder which is often discovered after extension to other organs. There are few indications for cancer of the digestive tract itself although laparotomy would be more sensitive than echography or computed tomography for recognizing hepatic or peritoneal metastasis. Palliative treatment via laparoscopy is just at its beginnings and will require continued development in techniques and material. Currently, palliative hyperthermia for peritoneal carcinoma is under clinical evaluation. The future role of curative laparoscopy for abdominal cancers must be evaluated on the basis of prospective protocols.